Provider Demographics
NPI:1235309980
Name:DR. MICHAEL YAVROM DPM PODIATRIST
Entity Type:Organization
Organization Name:DR. MICHAEL YAVROM DPM PODIATRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YAVROM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:650-961-1995
Mailing Address - Street 1:2500 HOSPITAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4106
Mailing Address - Country:US
Mailing Address - Phone:650-961-1995
Mailing Address - Fax:650-961-2781
Practice Address - Street 1:2500 HOSPITAL DR STE 1
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4106
Practice Address - Country:US
Practice Address - Phone:650-961-1995
Practice Address - Fax:650-961-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1204213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10825Medicare UPIN